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Prior R (13 September 2020). "Months after Covid-19 infection, patients report breathing difficulty and fatigue". CNN. Archived from the original on 2020-09-26 . Retrieved 2020-09-22. Gahan and others with long-haul Covid-19 symptoms face a condition called postural orthostatic tachycardia syndrome, which refers to a sharp rise in heart rate that occurs when moving from a reclining to standing position. The pull of gravity causes blood to pool in the legs. This condition can cause dizziness, lightheadedness and fainting. In the 30% to 60% of cases classified as hyperadrenergic POTS, norepinephrine levels are elevated on standing, [1] often due to hypovolemia or partial autonomic neuropathy. [29] A smaller minority of people with POTS have (typically very high) standing norepinephrine levels that are elevated even in the absence of hypovolemia and autonomic neuropathy; this is classified as central hyperadrenergic POTS. [29] [35] The high norepinephrine levels contribute to symptoms of tachycardia. [29] Another subtype, neuropathic POTS, is associated with denervation of sympathetic nerves in the lower limbs. [29] In this subtype, it is thought that impaired constriction of the blood vessels causes blood to pool in the veins of the lower limbs. [1] Heart rate increases to compensate for this blood pooling. [49] a b c d e f g h i j k l m Mar PL, Raj SR (2014). "Neuronal and hormonal perturbations in postural tachycardia syndrome". Frontiers in Physiology. 5: 220. doi: 10.3389/fphys.2014.00220. PMC 4059278. PMID 24982638. a b McDonald C, Frith J, Newton JL (March 2011). "Single centre experience of ivabradine in postural orthostatic tachycardia syndrome". Europace. 13 (3): 427–430. doi: 10.1093/europace/euq390. PMC 3043639. PMID 21062792.

Antibodies against the Alpha 1 adrenergic receptor and muscarinic acetylcholine M4 receptor [3] [4] [5] Aggravating factors include exertion (81%), continued standing (80%), heat (79%), and after meals (42%). [84] Medication [ edit ] a b c Raj SR (April 2006). "The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis & management". Indian Pacing and Electrophysiology Journal. 6 (2): 84–99. PMC 1501099. PMID 16943900. Khurana RK, Eisenberg L (March 2011). "Orthostatic and non-orthostatic headache in postural tachycardia syndrome". Cephalalgia. 31 (4): 409–415. doi: 10.1177/0333102410382792. PMID 20819844. S2CID 45348885.When changing to an upright posture, finishing a meal, or concluding exercise, a sustained hand grip can briefly raise the blood pressure, possibly reducing symptoms. [34] Compression garments can also be of benefit by constricting blood pressures with external body pressure. [34] Novak P (2016). "Cerebral Blood Flow, Heart Rate, and Blood Pressure Patterns during the Tilt Test in Common Orthostatic Syndromes". Neuroscience Journal. 2016: 6127340. doi: 10.1155/2016/6127340. PMC 4972931. PMID 27525257. POTS is more common in females than males. It has also been shown to be linked in patients with acute stressors such as pregnancy, recent surgery, or recent trauma. POTS also has been linked to patients with a history of autoimmune diseases, [51] Long Covid, [55] irritable bowel syndrome, anemia, hyperthyroidism, fibromyalgia, diabetes, amyloidosis, sarcoidosis, systemic lupus erythematosus, and cancer. Genetics likely plays a role, with one study finding that one in eight POTS patients reported a history of orthostatic intolerance in their family. [48] Autoimmunity [ edit ]

In adults, the primary manifestation is an increase in heart rate of more than 30 beats per minute within ten minutes of standing up. [1] [29] The resulting heart rate is typically more than 120 beats per minute. [1] For people between ages 12 and 19, the minimum increase for a POTS diagnosis is 40 beats per minute. [30] POTS is often accompanied by common features of orthostatic intolerance—in which symptoms that develop while upright are relieved by reclining. [29] These orthostatic symptoms include palpitations, light-headedness, chest discomfort, shortness of breath, [29] nausea, weakness or "heaviness" in the lower legs, blurred vision, and cognitive difficulties. [1] Symptoms may be exacerbated with prolonged sitting, prolonged standing, alcohol, heat, exercise, or eating a large meal. [ citation needed]

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a b Jacob G, Shannon JR, Costa F, Furlan R, Biaggioni I, Mosqueda-Garcia R, etal. (April 1999). "Abnormal norepinephrine clearance and adrenergic receptor sensitivity in idiopathic orthostatic intolerance". Circulation. 99 (13): 1706–1712. doi: 10.1161/01.CIR.99.13.1706. PMID 10190880. Knight J (2018). "Effects of Bedrest: Introduction and the Cardiovascular System". Nursing Times. 114 (12): 54–57. Archived from the original on 2022-08-10 . Retrieved 2022-08-10– via EMAP. Fludrocortisone may be used to enhance sodium retention and blood volume, which may be beneficial not only by augmenting sympathetically mediated vasoconstriction, but also because a large subset of POTS patients appear to have low absolute blood volume. [87] However, fludrocortisone may cause hypokalemia. [88] Zhang Q, Chen X, Li J, Du J (December 2014). "Clinical features of hyperadrenergic postural tachycardia syndrome in children". Pediatrics International. 56 (6): 813–816. doi: 10.1111/ped.12392. PMID 24862636. S2CID 20740649.

Bhatia R, Kizilbash SJ, Ahrens SP, Killian JM, Kimmes SA, Knoebel EE, etal. (June 2016). "Outcomes of Adolescent-Onset Postural Orthostatic Tachycardia Syndrome". The Journal of Pediatrics. 173: 149–153. doi: 10.1016/j.jpeds.2016.02.035. PMID 26979650.COVID-19 and POTS: What You Should Know". WebMD. Archived from the original on 2021-07-31 . Retrieved 2021-07-31. People with POTS can be misdiagnosed with inappropriate sinus tachycardia (IST) as they present similarly. One distinguishing feature is those with POTS rarely exhibit >100 bpm while in a supine position, while patients with IST often have a resting heart rate >100 bpm. Additionally patients with POTS display a more pronounced change in heart rate in response to postural change. [7] Treatment [ edit ] a b Busmer L (2011). "Postural orthostatic tachycardia syndrome: Lorna Busmer explains how nurses in primary care can recognise the symptoms of this poorly understood condition and offer effective treatment". Primary Health Care. 21 (9): 16–20. doi: 10.7748/phc2011.11.21.9.16.c8794.